School

psychologists role as experts in education and psychology affords us

an intricate understanding of the complex interactions that occur within school,

home, and community environments. The unique position that we have within the
educational system enables us to establish and reinforce connections between
students, their families, as well as school staff. Therefore, possessing the ability to
consult with parents, teachers, administrators, and community members to
ascertain the degree and underlying cause of a childs difficulties and, in turn,
collaborate to develop effective, evidence-based, interventions tailored to each
students individual needs, is vital to our success as educators. Ineffective or
inappropriate interventions may have the unintended consequence of further
increasing the educational disparity between students and their peers due to time
lost. All children, when given the proper support, would do well if they could, thus, it
is critically important to gather a range of quantitative and qualitative information
on a student so that school staff, parents, and other professionals are best equipped
to implement interventions with fidelity. Compiling a comprehensive body of
evidence prior to beginning consultation enables the school psychologist to design
and recommend the most effective interventions that are user-friendly and, thus,
more likely to be carried out, by the consultee, as intended.

A 2011 study, conducted in three secondary schools in Scotland, highlights

the need for school psychologists to offer support to their colleagues within the
educational environment (Boyle, Topping, Jindal-Snape, & Norwich). Forty-three
teachers were surveyed regarding a variety of topics, including their ability to feel
that they were providing students, including those in special education; with the
proper support needed in their classrooms. Interestingly, a majority of teachers
noted that, regardless of the degree of support they felt from their administration,
the support they received from their peers was viewed as a valuable component
enabling teachers to feel that they were able to successfully include children with
special needs (Boyle et al., 2011). Therefore, the ability of a school psychologist to
proactively consult with teachers to ensure their needs are being met and to offer
guidance, whenever possible, is key to supporting all students within the classroom.

The dynamic nature of the school psychologists role, demands that we, as a
profession, continuously strive to increase our visibility to all those we serve.
Moreover, the authors note, it is school psychologists who are best equipped to
bridge the divide between general and special education through consultation and
collaboration with the goal of increasing the instructional efficacy of both groups.

In an effort to elucidate the effects of teacher consultation by mental health

professionals in an at-risk, urban setting, researchers examined 36 classrooms

within five elementary schools. Outcomes of 364 students, of which 87% were
Latino and 11% were African American, were assessed in both the fall and spring
(Cappella, et al., 2012). Results indicated a significant positive increase in measures
of student relationship closeness, academic self-concept, and peer-victimization.
Notably, students with behavioral difficulties were significantly less likely to be
victimized when placed in classrooms that received consultation from mental
health professionals (Cappella, et al., 2012). Overall, the use of consultation may
have far reaching effects on student achievement as well as the degree of mental
health support that a student requires as they progress through the educational
system.

While it is clear that consultation and collaboration by school psychologists

with classroom teachers can have wide-ranging positive effects on students in

general education and some who receive special education services, including
students with specific learning disabilities (SLD); those students with more intense
needs, including those with an autism spectrum disorder or who have suffered a
traumatic brain injury (TBI), may stand to benefit most from the consultative model.

A recent study, conducted by Ruble, Dalrymple, and McGrew (2010)

examined the effects of teacher consultation using the Collaborative Model for
Promoting Competence and Success (COMPASS). COMPASS was designed to enable
parents and teachers to receive ongoing support from mental health professionals
regarding the unique needs of children with autism, throughout the school year, via
an initial parent-teacher consultation and four follow-up consultations with the
classroom teacher. The program is designed to target three key areas: social skills,
communication, and independence, viewed as vital to the success of students with

autism (Ruble, Dalrymple, & McGrew, 2010). Thirty-five teachers were paired with a
randomly selected child with autism. Results indicated that teachers and students
who received regular consultation, using the COMPASS system, demonstrated
significantly greater improvements in the outcomes of their individualized
education programs (IEPs) as compared to those who did not receive consultation
(Ruble, Dalrymple, & McGrew, 2010). These findings appear to illustrate the need
for increased consultative supports for teachers who have students with special
needs.

Along with autism, the increasing prevalence, within education, of children

with traumatic brain injuries (TBIs), has necessitated a shift in focus by school
psychologists toward providing classroom-level supports for students with
challenges that are often unique and variable. In 2012, researchers sought to
determine the effects of risk and protective factors, including home, school,
religious, and social influences, on children with TBIs (Gerring & Wade). The
concept of risk and protective factors is rooted in the ecological theory of child
development, which states that children develop through a series of interactions
with their environment. Therefore, the more that we, as mental health professionals,
can determine about the characteristics of students past and present environments,
the more likely we are to have a positive impact on their development (Gerring &
Wade, 2012). Consistent with the variability in presentation seen in children who
have experienced a traumatic brain injury, it is likely that there is no universal set of
risk and protective factors that will either help or hinder all those with TBIs;
however, gathering and compiling information obtained from parents, teachers, and
outside medical professionals will support our ability to conduct consultations that
result in the implementation of highly effective interventions.

In order to maximize the efficacy of the consultative model, it is important to

carefully select a method of consultation that is both research-based and well suited
to the needs of the client. One method demonstrated to have a high degree of
efficacy is the Problem Solving Model. This consultative approach typically consists
of five to seven steps (see above) designed to carefully guide the interactions of the
consultant and consultee (client) (Kratochwill et al., 2012). The first step is the
identification of the problem, which is often initially performed by the client. Both
individuals then engage in a collaborative exploration of possible root causes of the
problem. A list of goals is mutually agreed upon by, followed by a set of alternative
solutions to the problem. A set of actions or interventions is then selected. Next, the
consultee carries out these interventions over several weeks with regular
evaluation and monitoring throughout the process. Finally, subsequent to the
results of the evaluations by the consultant, client-driven interventions are either
continued, if improvement is evident, or, if an adequate degree of change has not
been shown, the problem is reanalyzed from the beginning of the cycle.

The following artifact illustrates my ability to function as the leader of a

consultative team focused on gathering the highest degree of information possible

in relation to a students needs, developing highly effective interventions targeted at
the remediation of skill deficits, engaging in frequent progress monitoring, as well as

regularly consulting with various team members to modify, adjust, and re-
implement interventions as necessary.

Background Information

The following consultation centers around a student named Cory Lawrence.

Cory is a 7-year-old male who is currently enrolled at Denison Montessori School in

the first grade. He has attended Denison since age 4. Cory receives special education
services from the school psychologist intern, occupational therapist, and special
education teacher under the disability category of traumatic brain injury (TBI). His
current classroom teacher is Ms. Jones, a lower elementary instructor who teaches
grades 1st 3rd. It should be noted that a central tenet of the Montessori philosophy
is that students remain with the same instructor for three full years in order to
maximize the students familiarity and comfort with both their instructor and the
educational environment.

Cory was born at 41 weeks gestation, weighing 7 pounds, 3.5 ounces. He

experienced fetal distress as a result of prolonged labor and remained in the

hospital for three days before being discharged without the need for follow-up care.
At 11 months of age, Cory sustained a traumatic brain injury, noted as having been
caused by a fall on a concrete step. A CT scan completed in the ER following the
injury failed to reveal any significant concerns and Cory was sent home with his
mother. Over the next two weeks, he began to experience symptoms including
vomiting and lethargy, which ultimately resulted in a seizure. He was placed in the
pediatric intensive care unit (PICU) for approximately six days in October 2008. His
mother had indicated that he had not experienced any significant medical issues
since the time of his TBI and was not currently taking medication.

During the 2013-14 school year, Cory was in a primary classroom with

students aged 3, 4, and 5. He struggled throughout the year with toileting, despite
being nearly six years of age. The previous school psychologist worked with the
hallway/restroom paraprofessional to create a reward system in which Cory earned
a sticker for every time he successfully used the restroom. This resulted in him
successfully becoming toilet trained at school in January 2014.

Additionally, the previous school psychologist noted that he had difficulty

with behavior in the classroom. The demands of the Montessori classroom,

including the expectation for learning to be primarily self-directed proved to be a
significant challenge for Cory. When he reached a heightened state of emotional
arousal, he would often hit or kick other students or staff, knock objects off the
shelves, or throw items across the room. These behaviors resulted in multiple
classroom evacuations throughout the year, including one incident, during the
spring semester, which resulted in significant damage to classroom materials and
school property, and ultimately led to DPS Safety and Security being dispatched to
assist with de-escalation.
Current School Year (2014-15)

During the first week of school, I initially met with Corys new classroom

teacher, Ms. Jones, along with his previous teacher to discuss intervention strategies
that had been successful in working with Cory last year along with suggestions for
setting him up for success within the classroom. His previous teacher noted that the
level system he had been on had been successful initially but its effectiveness had
started to fade as the year progressed for reasons she could not specify. Moreover,
she indicated that he had difficulty with transitions, both inside and outside of the
classroom, was often reluctant to begin new or more challenging work, and
frequently appeared to be tired and more irritable during the afternoon. I decided to
observe him during the following week and begin to update his level system to
better reflect his new environment.
9/2/14 Classroom Observation

I came in to the classroom to observe Cory during the afternoon. He spent

much of the first ten minutes playing with pattern blocks, a Montessori work, but
one that his teacher had indicated he favored heavily and was probably the one
work in the classroom most similar to those found at the primary level. Ms. Jones
attempted to redirect him by saying, Cory, it is time to let someone else use that
work on three separate occasions; however, Cory glanced up at her only briefly on
the first attempt and subsequently appeared to ignore her. He was also observed to
be fidgeting by pulling on his shirt and pants multiple times. Later, Ms. Jones

instructed the class to clean up their work and come get a piece of paper and some
paint off of her table for the next lesson. She then repeated this instruction to Cory
two more times before he began to clean up several minutes later. He then went and
got a piece of paper, wandered around until he found a spot in the group he liked,
and asked Ms. Jones for some paint.
9/3/14 Initial Meeting with Corys Mother

During my first meeting with Corys mother, Ms. Lawrence, I shared with her

the results of my observation and she indicated that she had often seen similar
behavior at home. She expressed frustration that his behavior had not improved
after he became toilet trained as she had expected that it would. I began to ask her
questions about the familys history. Ms. Lawrence shared that Cory had been
subject to physical trauma from his father prior to sustaining a traumatic brain
injury, but declined to share specific details. She also reported that the family had a
history of mood disorders with she having been diagnosed with Bipolar disorder
and her ex-husband, Corys father, with major depressive disorder. Next, I asked her
to describe Corys typical reaction when he became angry or frustrated. Ms.
Lawrence reported that while he would sometimes scream or become physically
aggressive (e.g. hitting, kicking), he was often more likely to retreat to his room and
hide under a blanket or in the closet. Lastly, I mentioned to her that Cory might
benefit from outside therapy, either individually or as a family, to help supplement
the supports he was receiving in school, and provided her with resources for
Childrens Hospital, University of Denver Counseling Center, and the Mental Health
Center of Denver (MHCD).
9/11/14 Consultation with Ms. Jones

The next time I met with his classroom teacher, I presented the updated level

system and lanyard cards that she and all other staff members with whom Cory
interacted would wear (see below).

I borrowed the three colors from the original level system and added a series

of pictures at each level to help Cory better understand his behavior. At the green
level, working nicely, keeping his hands and feet to himself and other pro-social
behaviors would allow him to earn ten minutes of time to build Legos at the end of
the day with either myself or the special education teacher. This reward was later
expanded to include supervised outside recess time and Pokmon later in the year.
Within the yellow level, picture cards provide clear examples of behaviors that Cory
would commonly engage in when first becoming frustrated. The large reset button
indicated to him that he needed to take a timeout and that if, after several minutes,
he could rejoin the class and continue working, he would return to the green level
and continue to be able to earn his time building Legos. If, on the other hand, his
behavior escalated to the red level, including hitting or kicking his teacher or peers,
an administrator would be called to get him and he would lose his Lego time for the
day. The four cards to the right were each attached to multiple lanyards, worn by all
adults who work with Cory, serving as a continuous visual reminder of his progress.

Overall, Ms. Jones seemed hopeful that the changes that had been made

would allow Cory to be more successful in her classroom. I mentioned to her that

the easiest way for him to view his level system chart would be to create a
designated workspace for him within the classroom. This would serve the dual
purpose of adding routine and structure to the classroom environment, while also
helping to avoid conflicts between him and peers over sharing space. His teacher
was initially hesitant because one tenet of the Montessori philosophy emphasizes
that students must be free to explore and interact with all aspects of their
environment absent restriction.

I did not know it at the time; but the need for structure and routine, common

to most children who have experienced a TBI, was something that would
continuously come in conflict with the freedom of movement and expectation of
intrinsic motivation characteristic of the Montessori classroom.
9/26/14 IEP Meeting

At Corys annual IEP meeting, I presented his updated functional behavioral

assessment, behavior intervention plan as well as his crisis plan (FBA/BIP/Crisis) to

members of the IEP team including: his mother, Ms. Lawrence; Ms. Jones; the special
education teacher; principal; and occupational therapist. His updated plan included
the ability for him to earn time building Legos, both during lunch and at the end of
the day, as his difficulties with sustaining pro-social behavior suggested the need for
more frequent rewards.

I also provided Ms. Jones with copies of the feelings thermometer, five basic
emotions sheet, and strategies for calming down (see above) that I had been
working on with Cory since the beginning of the school year. I suggested to her that
she utilize the feelings thermometer and/or emotions page both before and after
transitions as a way of checking in with Cory.

In the two weeks following his IEP meeting, Cory began to experience

increased difficulty with regulating his emotions and had to be removed from the
classroom on several occasions by the school psychologist intern and/or principal.
Conversations with Ms. Jones revealed that these outbursts were most likely to
occur during the afternoon or during specials and least likely to occur in the first 90
minutes of the day. The fact that I was only at Denison part-time coupled with the
extensive mental health needs of a variety of students in the building, meant that I
was unable to witness or participate in many of these events, hindering my ability to
ascertain their true antecedents and consequences.
10/14/14 Initial Meeting with District Support Partners

At the request of Denisons principal, two district-level support partners, one

from special education and one from the office of social emotional learning, which
oversees school psychologists and social workers, were called in to provide
assistance to the building team. The principal presented a graph of all office referral
data on Cory since the beginning of the year that had been entered into SWIS, our
behavior and discipline tracking system. The graph illustrated a marked increase in
significant behavioral incidents between 1:00 and 1:45PM. After significant
discussion between the various team members and the mental health partner, a
hypothesis was reached that because Cory goes to recess everyday from 12:30-1:00,
it was likely that this activity was having a negative impact on his ability to manage
his emotions during the subsequent transition back into the classroom. Ms. Jones
added that for the first 15 minutes they are back in the classroom following
lunch/recess, the entire class gathers in a circle for class meeting, which includes
sharing successes and difficulties from the morning work period and plans for the
afternoon. She indicated that she had noticed Cory struggle to join the group on

multiple occasions, instead either wandering around the back of the classroom or
grabbing his jacket and hiding in it, by zipping it up all the way over his head.

On the basis of this new information, I posited to the team that the cause of

Corys difficulties following recess might be related to sensory processing issues,

which are often seen in children with TBIs, whereby the degree of energy and
activity occurring in the environment around them leads to a state of hyperarousal.
The mental health partner concurred that once a child reaches this heightened state
of reactivity, particularly when sustained over a long period such as 30 minutes, it
can be a long time before they are able to readjust to the relative calm of the
classroom. Next, the special education partner made the suggestion that Cory be
placed on a half-day schedule, temporarily, with Ms. Lawrences permission, while
the team worked to implement new interventions, with the goal of enabling him to
be successful at school throughout the entire day. Additionally, the district partners
proposed removing Cory from recess for the time being and having him spend this
time, from 12:30 1:15, with either the special education teacher or me, depending
on our schedules. I, along with the OT and Corys mother, expressed concerns about
him missing all of his recess time, so we decided to have him exercise for 20 minutes
every morning with the physical education teacher. The team decided to reconvene
in three weeks to discuss his progress.

Later that week, I introduced Cory to a new curriculum intended to help him

identify and manage his negative emotions. The book, entitled Boom the Anger
Tamer, tells the story of an Emote, or character with social-emotional needs, who
has difficulty dealing with his anger (see below). After he tries, unsuccessfully, to
bottle it up or to run away from it, his mentor gives him advice to confront it once
and for all.

11/5/14 Follow-Up Meeting with District Partners

During the follow-up meeting, it was determined that the number of

explosive episodes Cory had experienced since the new interventions were put in
place was reduced by about 40%. His mother requested that he be returned to full
days as soon as possible because she was concerned about him missing valuable
educational time. I empathized with her concerns and ultimately made the
suggestion that he be slowly reintroduced to a full-day schedule via staggered
increases of approximately 45 minutes (the length of a specials class) per week from
now until the end of the semester. The team, including Ms. Lawrence, agreed and
Ms. Jones volunteered to draft a weekly schedule to help the team remain consistent
with Corys shifting schedule.
12/18/14 Consultation with Ms. Jones

Subsequent consultation with Ms. Jones revealed that Cory was having

difficulty adhering to the daily work plan that I had suggested she have him write in
his planner. In the last week, he had only written in the planner during 2/5 days and
often chose to skip over any non-preferred activities that Ms. Jones suggested he
include. Together we agreed that the work plan was lacking in both visuals and
color as well as the ability for it to be manipulated by hand, as Cory had been shown
to be a highly kinesthetic learner, with a strong preference for piecing together
puzzles and building objects. Ms. Jones provided me with a list of approximately a
dozen Montessori work activities that could be represented visually on the work
plan (see below). The daily work plan was divided into morning and afternoon
activities, with the requirement for at least two, relatively simple, although non-
preferred, works to be completed before being able to more on to preferred
activities (e.g. puzzle maps, addition finger chart).